Opioid therapy for osteoarthritis and chronic low back pain

Abstract

Background: Chronic low back pain (CLBP) and osteoarthritis (OA) of any joint are highly prevalent, occurring in > 50% of US adults aged ≥ 60 years. Opioids are prescribed more frequently for CLBP and OA than for any other noncancer pain, and the judicious use of opioids is recommended by treatment guidelines for the management of CLBP and OA pain.

Objective: To review the appropriate role of opioid analgesics in the treatment of patients with moderate-to-severe pain due to CLBP or OA and provide recommendations for best practices when prescribing opioids.

Methods: Articles were identified through a search of PubMed. Additional references were identified for inclusion from the reference lists of articles identified via the literature search, treatment guidelines, and Cochrane Reviews.

Results: The available data suggest that opioid therapy represents a valuable treatment option in patients who do not respond to other analgesics and in whom the potential benefits of treatment outweigh the potential risks. Prescribing physicians need to perform vigilant patient screening and monitoring for signs of abuse, intervene promptly to manage or prevent adverse events and drug interactions, tailor opioid therapy to individual patients' comorbidities, and know how to switch or rotate opioids to find the best treatment option.

Conclusions: Prescribers need to understand the place of opioid therapy in a multimodal treatment program that includes patient rehabilitation to reduce pain and improve function. The analgesic benefits of opioids must be balanced against concerns about addiction and abuse, adverse events, and their potential impact on other aspects of treatment.